Musculoskeletal physiotherapy is the most common intervention for chronic
low back disorder. Any observation on clinical practice or investigation into
the clinical and scientific literature indicates that musculoskeletal
physiotherapy encompasses a plethora of treatment modalities and
approaches. The aim of the present investigation was to determine the most
common intervention(s) that comprise musculoskeletal physiotherapy and to
critically explore their empirical therapeutic basis. Two components were
highlighted as the most frequently employed interventions; namely manually
applied therapy (manual therapy) and exercise(s) to rehabilitate the lumbar
spine's stabilising system. In the course of an extensive literature search,
work was uncovered that suggested that the mechanisms required for spinal
stability could be better facilitated using methods other than those in current
clinical use. These discoveries culminated in the creation of a ten-week
rehabilitation programme which was primarily developed to facilitate
rehabilitation of spinal stabilisation but also permitted an empirical analysis of
this component of musculoskeletal physiotherapy. The efficacy of the regime
was then assessed in comparison to manual therapy and to a control (an
education booklet) in a randomised controlled trial.
Following a series of pilot studies, 300 patients with chronic low back disorder
were randomly assigned to groups and completed their respective
management programmes. Data were collected on pain, disability, handicap,
impairment and quality of life prior to entry and at three, six, twelve and
twenty-four months post intervention. The results indicated a consistent trend
for greater improvement in the spinal stabilisation group in the pain, handicap,
impairment, disability, dysfunction and medication variables. These trends
reached statistical significance at the three-month follow-up stage as
evidenced by quality of life (P = 0.025), at the six-month follow-up stage in
pain (P = 0.009) and dysfunction (P = 0.042) and at the one-year follow-up
stage in medication (P = 0.007), dysfunction (P = 0.048), disability (P =
0.0098) and quality of life (P = 0.003). It was therefore concluded that the
spinal stabilisation programme was a more effective component of
musculoskeletal physiotherapy (when analysed in isolation) than manually
applied therapy or an education booklet in the management of chronic low
back disorder.
Various sub-analyses of the data were conducted. Subjects who entered the
study with high levels of low back pain (greater than 50 numerical rating scale)
demonstrated a statistically Significant reduction in pain levels (P = 0.04) in
both the manual therapy group and the spinal stabilisation group in
comparison to the education control group at the three-month follow-up stage.
These data provide empirical evidence towards the efficacy of these two
musculoskeletal physiotherapy management regimes as being effective in
pain reduction in comparison to an active control intervention. This has not
hitherto been demonstrated on patients with chronic low back disorder.